The idea of heroin maintenance is not new. Britain has been doing it in a small ad hoc way for decades. Switzerland has had such excellent results with their programme that 71% of the Swiss people voted in a referendum to keep it as a treatment option in their country. The Dutch have started a heroin programme too.

A few brave people in the Australian Capital Territory thought that Australia could also benefit from offering its heroin addicts a safe, regulated supply. I say brave because any such undertaking is invariably met with cries of "Enabler!" or "Legalizer!" if not straight out "Drug Pusher!" It was not to be - yet. Although it had a lot of support, even among politicians and the media, the conservative government baulked at so direct an approach.

Personally, as one who could directly be advantaged, or disadvantaged by legal heroin distribution, I think that a heroin programme would be a good idea. It would give people another option besides feel like shit or live like shit.

But let's have a look at some of the arguments against heroin maintenance (if anyone wants their argument added in here write it either in an e-mail or in the guestbook and I'll add it in... I'm fully prepared to give the other side their whole range of arguments) I have listed the arguments against first by number and linked each argument with its refutation below:

1. It would be more difficult for addicts who want to give up.



2. People who are not addicts could become addicts by going on the program.



3. Addicts would have no incentive to become abstinent.



4. It would be giving addicts just what they want.



5. It would be like giving alcoholics alcohol or cigarettes to smokers



6. In the Swiss trials only a very small number of people got off heroin

1. Heroin maintenance would make it harder to give up heroin. I don't think so. When people try to give up heroin, they have to put up with it being all around them anyway. We spend long hours looking at the telephone telling ourselves 'no'. When we weaken the person on the other end is more than happy to accommodate us. Would it really make any difference to our self control if the person on the other end was a doctor instead of a dealer? Perhaps it would, in the other direction probably! No, this idea is based on the fallacy that making heroin illegal makes it harder to obtain.

2. People who are not addicts could become addicts by going on the program. Ask the people who forward this argument if they would become a heroin addict just because they could get free heroin; the answer will be, "Definitely not!!!" Yet, these people think that everyone else will. People who have never touched heroin before will suddenly think "Oh wow, there's a heroin program open now, let's go get some heroin!" These people also tend to favour censorship, because the 'lesser entities' of our society cannot think for themselves and will swallow every misguided idea presented to them. Society, at large, (except for them and their friends/followers/supporters) is an unwieldy, unstable conglomeration of bestial creatures who need strict rules and laws (and plenty of police to enforce them) to save them from themselves.

   I really do not think that it would make a great difference in whether people take up heroin. But, let's for a moment give them their argument. Let's say that it would enable people to become addicts more easily. What would be the practical result of that? People become addicts even without heroin programs in place. Is it preferable to become an addict on unsafe, unregulated black market heroin or on safe, regulated, medically supervised heroin? Which would you prefer your child to take, assuming that he/she had made the decision to take heroin and nothing you say will stop him/her? Is there really a comparison where you have on one hand a certain number of heroin addicts who are societal outcasts, living in appalling conditions, never knowing if the next shot means death; and on the other hand where you have more addicts, but all are living comfortably, know the strength and content of their next shot and can function normally (if they so choose) within society's expectations.

3. Addicts would have no incentive to become abstinent if they were receiving clean, safe, affordable heroin. Again there is more than one approach to this argument. Firstly, the argument stinks of that "heroin addicts are no good, lazy freeloaders, who have no ambition greater than getting their next hit" stereotype. Secondly, I can think of plenty of reasons like:

   • not having to be chained to a doctor/pharmacy/clinic every day;
   • being able to travel without making arrangements weeks beforehand; and too bad if there's nowhere available for your dose to be picked up, (sorry, all clinics in that area are full at the moment, would you consider seeing your dying mother next month?);
   • overseas travel becomes a realistic possibility
   • the plain 'ol ambition, which many of us have, to be drug-free (whether this is something from within or something that has been socialised into us as desirable doesn't really matter in this context);
   • being free of the gut-wrenching, sickening fear that tomorrow you will not be able to get what you need for whatever reason;
   • just feeling free.
   All of which would encourage me to become opiate/opioid free tomorrow, if I didn't firmly believe that I am taking opioids as a medical necessity (see My autobiography, Part 1). Why do smokers or alcoholics, or methadone patients stop? Self-improvement is just as big a consideration to a heroin addict as to anybody else.

4. It would be giving addicts just what they want. Well forgive my stupidity but, what the hell is wrong with that?? If you have a section of the population who are desperate for something, so much so that it controls their whole life and takes a toll on those around them and even the wider society, isn't it in everyone's interest to see that they get it? I never did understand this argument.

5. It would be like giving alcoholics alcohol or cigarettes to smokers. The comparison of heroin maintenance with giving alcohol to alcoholics and cigarettes to smokers is a common one, though it is not really thought through very well. There are two categories that all addicts fit into, whether the addiction is heroin, nicotine, gambling or anything: addicts who are actively trying to give up and addicts who are not.

   Addicts who are not actively trying to give up includes those who may think that they would be better off without their addiction, but haven't been moved to do anything about it yet, eg. a smoker who is worried about the damage they are doing to their lungs; or a gambler who has trouble paying bills. They can see that they would be better off without their addiction but, for whatever reason, (they enjoy a smoke, quitting is too hard, etc.) don't. It also includes those who don't think (or won't admit to themselves) that they have an addiction. It also includes those who enjoy the activity that makes up their addiction - many alcoholics, for instance, enjoy going out and drinking socially.

   Whatever the reason for not giving up, most addicts in our society are able to indulge their particular addiction legally and safely. Smokers buy their expensive, but affordable, cigarettes from any corner store; alcoholics go to any pub, bottle shop, and now many restaurants. So you see... we *do give alcohol to alcoholics and cigarettes to smokers*!

   Not heroin addicts. They must associate with criminals, often become criminals themselves, they have no idea of what, exactly, is in that next shot, hundreds die every year from causes that are directly attributable to the unregulated status of the drug.

6. Only a small percentage of the Swiss participants in heroin maintenance became abstinent. That may be so, but those who did not become abstinent still benefited greatly. Their quality of life was greatly increased; many became employed; crime, and this is a very important factor, among participants was reduced to almost zero. I believe that these consequences far outweigh whether someone has become abstinent or not.

   You see, the problem is that the media, politicians, the public at large, can't abide the thought of someone not wanting to get off heroin. So heroin trials must be seen as a path to abstinence. I see heroin trials more as a way to improve the lives of heroin addicts, than as an abstinence strategy.

   Having said that, I also believe that a person would have more chance of becoming abstinent if they were part of a maintenance program than if they were buying from dealers. When an addict is buying street drugs they spend all their time, money and energy chasing the next hit. There is no time for thought or regret. You become an automaton - work, score, work, score (whatever work is - for me it was prostitution and dealing drugs, for some it is other forms of crime like stealing, I have even seen people begging). Being a heroin addict is a full time job. If an addict was being legally maintained on heroin though, this atrocious lifestyle is stopped. There is time for thought and regret. You suddenly have time on your hands. Some people get a job, some get a hobby, whatever, the addict now can do something besides being an addict. Self-esteem improves and then the addict can think about getting off for the right reasons. Getting off because you truly want to get off, not because someone has been pressuring you or circumstances are forcing you to. Failure usually results from trying to give up for the wrong reasons - and that is bad for self-esteem. Low self-esteem only exacerbates any problems.

   Having someone else doling out your heroin also opens the opportunity for tapered heroin withdrawal. At the moment, if abstinence is your goal, you can either detox somehow from whatever heroin habit you've accumulated or go on to methadone for a reduction program. Unfortunately methadone takes much longer to withdraw from than heroin, but trying to taper your own heroin use is very difficult. If the reduction could be done just with heroin instead of having to swap over to methadone to reduce, some people may be able to detoxify much more easily.

When you strip all the arguments against taking drugs down to their bare bones, they basically rest on one foundation: the idea of a drug free society. It is an ideology as misguided as a mixed-marriage free society or a homosexual free society. But it is the accepted ideology of our times. Drug prisoners are, therefore, political prisoners because their crime is a crime against the ruling ideology.

I have no doubt that not too far in the future the 'drug free' phase of our culture will be looked upon in much the same way as other legally enshrined discriminatory practices in the past. The Americans being put in jail now for handing out clean needles will be seen in the future as we now see Emily Pankhurst, Oscar Wilde and Nelson Mandela.

As far as arguments for a heroin maintenance program, I think most are covered above in the refutations of the arguments against: it would save lives, improve lives, reduce crime and make the world a more tolerant, understanding and forgiving place.

Links

If you would like to see more about the medical distribution of heroin here are links to a very few of the many available resources on the web.

• Working Papers Feasibility Research into the Controlled Availability of Opioids. "The ACT Heroin Trial"

• The Lindesmith Center's index of articles on Heroin Maintenance Everything you ever wanted to know is here... if you can get through it all!

• The report of the External Panel on the Evaluation of the Swiss Scientific Studies of Medically Prescribed Narcotics to Drug Addicts (conducted in three phases between 1995 and 1998 for the WHO Substance Abuse Department), is available as an e-mail from demolisl@who.ch

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